RN- Mid-term Exam- 1228-01

The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating?

• Serum sodium level • Serum potassium level • Blood glucose level Explanation: Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. Electrolyte disturbance is common for the nurse to report. Sodium retention is typically accompanied by potassium depletion. Clients exhibit frequent hyperglycemia. There is no impact of the blood levels or kidney function.

parathyroid

four glands embedded in the thyroid; secretes parathyroid hormone; controls announces level of calcium and phosphate (which influence levels of excitability

A client reports experiencing vulvar pruritus. Which assessment factor may indicate that the client has an infection caused by Candida albicans? 1. Cottage cheese-like discharge 2. Yellow-green discharge 3. Gray-white discharge 4. Discharge with a fishy odor

1. Cottage cheese-like discharge RATIONALES: The symptoms of C. albicans include itching and a scant white discharge that has the consistency of cottage cheese. Yellow-green discharge is a sign of Trichomonas vaginalis. Gray-white discharge and a fishy odor are signs of Gardnerella vaginalis. NURSING PROCESS STEP: Assessment

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: 1. fresh fruits. 2. dairy products. 3. processed meats. 4. cereals and grains.

1. fresh fruits. RATIONALES: Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium. NURSING PROCESS STEP: Implementation

Addison's disease.

Adrenal hypofunction I.V. hydrocortisone for clients in acute adrenal crisis is the proper treatment 2 organs: adrenal medulla, epinepherine and dopemine adrenal cortex: norepinepherine, mineralocorticoids and glucocorticoids, such as aldosterone and cortisol is a long term endocrine disorder in which the adrenal glands do not produce enough steroid hormones.[1] Symptoms generally come on slowly and may include abdominal pain, weakness, and weight loss. Darkening of the skin in certain areas may also occur. Under certain circumstances an adrenal crisis may occur with low blood pressure, vomiting, lower back pain, and loss of consciousness. An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection.[1] Addison's disease arises from problems with the adrenal gland such that there is not enough of the steroid hormone cortisol and possibly aldosterone.[1] This is most often due to damage by the body's own immune system in the developed world and tuberculosis in the developing world.[2] Other causes include certain medications, sepsis, and bleeding into both adrenal glands.[1][2] Secondary adrenal insufficiency is caused by not enough ACTH (produced by the pituitary gland) or CRH (produced by the hypothalamus). Despite this distinction, adrenal crises can happen in all forms of adrenal insufficiency. Addison's disease is generally diagnosed via blood tests, urine tests, and medical imaging.[1] Treatment involves replacing the absent hormones.[1] This involves taking a corticosteroid such as hydrocortisone and fludrocortisone.[1][3] These medications are usually taken by mouth.[1] Lifelong, continuous steroid replacement therapy is required, with regular follow-up treatment and monitoring for other health problems.[4] A high salt diet may also be useful in some people. If symptoms worsen, an injection of corticosteroid is recommended and people should carry a dose with them. Often large amount of intravenous fluids with the sugar dextrose is also required. Without treatment an adrenal crisis can result in death.

Propranolol A client prescribed propranolol calls the clinic to report a weight gain of 3 lbs (1.36 kg) within 2 days, shortness of breath, and swollen ankles. What is the nurse's best action?

Beta-blocker- It can treat high blood pressure, chest pain (angina), and uneven heartbeat (atrial fibrillation). It can also treat tremors and proliferating infantile hemangioma. In addition, it can prevent migraine headaches. Have the client come to the clinic in order to assess the lungs. Explanation: The client needs to be assessed for the heart failure, a potential adverse effect of beta blockers. The other answer choices will not rule out the possibility of the development of pulmonary edema

Cardiac Output

Cardiac Output Cardiac Output = Heart Rate * Stroke Volume Normal 4-8 LPM Heart Rate Stroke Volume Press Here: Calculate Output

hypothyroidism

Cold intolerance Lithium, amiodarone, sulfonamides A disorder caused by a thyroid gland that is slower and less productive than normal Nurse should monitor for constipation which is a clinical manifestation of hypothyroidism as a result of decreased metabolism causing slow motility of the GI tract Myxedema The classic lab finding for hypothyroidism is a high TSH with low free T4(no not confuse with total T4) Levothyroxine High TSH, Low T4, Normal/Low T3 indicates

cushings disease

Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump

PQRST

P = atrial depolarization QRS = ventricular depolarization Q = septal depolarization R = ventricular depolarization S = downward deflection following R wave T = ventricular repolarizaiton

respiratory distress or hypoxia- symptoms

Rapid and shallow respirations, asymmetric chest movements, and nasal flaring

posterior pituitary

Releases ADH and oxytocin This part of the pituitary does not produce hormones, but stores and releases oxytocin and ADH.

DIABETES INSIPIDUS

caused by insufficient production of the antidiuretic hormone or by the inability of the kidneys to respond appropriately to this hormone

The nurse just received shift report for a group of clients on the telemetry unit. Which client should the nurse assess first. 1. The client with a history of atrial fibrillation 2. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block 3. The client with a history of heart failure who has bibasilar crackles and pitting edema in both feet 4. The client with a demand pacemaker whose monitor shows normal sinus rhythm at a rate of 90 beats/minute

2. The client admitted with first-degree atrioventricular (AV) block whose cardiac monitor now reveals type II second-degree AV block RATIONALES: The client whose cardiac rhythm now shows type II second-degree AV block should be assessed first. The client's rhythm has deteriorated from first-degree heart block to type II second-degree AV block and may continue to deteriorate into a lethal form of AV block (known as complete heart block). The client with a history of atrial fibrillation whose monitor reveals atrial fibrillation doesn't need to be assessed first. Because his rhythm is chronic, he has most likely been given an anticoagulant and isn't at immediate risk from this rhythm. The client with a history of heart failure may have chronic bibasilar crackles and pitting edema of both feet. Therefore, assessing this client first isn't necessary. The client's demand pacemaker fires only when the client's intrinsic heart rate falls below the pacemaker's set rate. In option 4, the pacemaker isn't firing because it most likely has been set at a slower rate than the client's intrinsic heart rate of 90 beats/minute. NURSING PROCESS STEP: Implementation

During rectal examination, which finding would be further evidence of a urethral injury? 1. A low-riding prostate 2. The presence of a boggy mass 3. Absent sphincter tone 4. A positive Hemoccult

2. The presence of a boggy mass RATIONALES: When the urethra is ruptured, a hematoma or collection of blood separates the two sections of urethra. This may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood would probably correlate with GI bleeding or a colon injury. NURSING PROCESS STEP: Assessment

When measuring the radial pulse of a client with known aortic insufficiency, the nurse isn't surprised to find a "water-hammer" or Corrigan's pulse. What are the characteristics of this pulse? 1. Weak and feeble, with a slow upstroke and prolonged peak 2. Alternating strong and weak beats 3. Rapid upstroke with two systolic peaks 4. Bounding, with a rapid rise and fall

4. Bounding, with a rapid rise and fall RATIONALES: A "water-hammer" pulse is bounding, with a rapid rise and fall. A weak, feeble pulse with a slow upstroke and prolonged peak is called pulsus tardus. A pulse with alternating weak and strong beats and a regular rhythm is termed pulsus alternans. A pulse with a rapid upstroke and two systolic peaks is called pulsus bisferiens. NURSING PROCESS STEP: Assessment

SAIDH

Excessive ADH release is called what syndrome of inappropriate antidiuretic hormone--persistent release of antidiuretic hormone. Excessive reabsorption of water, abnormal retention of water, hyponatremia. hypertonic urine, hypervolemia

A nurse is caring for a client in labor. Which assessment finding indicates fetal distress?

Fetal blood pH less than 7.2 Explanation: A fetal blood pH less than 7.2 is an indication of fetal hypoxia. During labor, a fetal pH range of 7.2 to 7.3 is considered normal. Fetal blood is sampled from the fetal scalp through a dilated cervix. Lack of meconium staining, early decelerations in fetal heart rate during contractions, and an increase in fetal heart rate with fetal scalp stimulation are all normal findings.

pituitary

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. Regulates and controls the activities of all other endocrine glands a small, somewhat cherry-shaped double structure attached by a stalk to the base of the brain and constituting the master endocrine gland affecting all hormonal functions in the body, consisting of an anterior region ((anterior pituitary) or (adenohypophysis)) that develops embryonically from the roof of the mouth and that secretes growth hormone, LH, FSH, ACTH, TSH, and MSH, a posterior region ((posterior pituitary) or (neurohypophysis)) that develops from the back of the forebrain and that secretes the hormones vasopressin and oxytocin, and an intermediate part (pars intermedia) derived from the anterior region but joined to the posterior region, that secretes the hormone MSH in lower vertebrates.

hyperthyroidism

an over secretion of thyroid that leads to high metabolism and exopthalmia goiter Grave's disease Hypersecretion of thyroxine from immune system attacking thyroid gland causing anxiety, irritability, insomnia, tachycardia, tremors, diaphoresis, sensitivity to heat, weight loss, exophthalmos and photosensitivity, diarrhea A thyroid-stimulating hormone (TSH) test, which is a blood test that measures your levels of TSH. If your TSH level is low, your doctor will want to do more tests. Thyroid hormone tests, which are blood tests to measure your levels of two types of thyroid hormones, called T3 and T4.

Cushing's syndrome

is associated with excessive amounts of glucocorticoids.

anterior pituitary

produces 6 major hormones Ex.: GH, PRL, FSH, LH, TSH, ACTH Gland in the brain that releases many hormones, including growth hormone, luteinizing hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, and follicle-stimulating hormone This gland releases prolactin into the blood effecting milk production and ejection. It is susceptible to stress Prolactin: released by _____

diaphoresis

profuse sweating

Which respiratory pattern indicates increasing intracranial pressure in the brain stem?

slow, irregular respirations Explanation: Neural control of respiration takes place in the brain stem. Deterioration and pressure produce slow and irregular respirations.

vasodialation

the dilatation of blood vessels, which decreases blood pressure.

addisons

tx: give juice/NA+ wgt daily

A nurse explains to a client with thyroid disease that the thyroid gland normally produces:

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A client with mitral stenosis comes to the physician's office for a routine checkup. When listening to the client's heart, the nurse expects to hear which type of murmur? 1. Pansystolic, blowing, high-pitched 2. Systolic, harsh, crescendo-decrescendo 3. Diastolic, blowing, decrescendo 4. Diastolic, rumbling, low-pitched

4. Diastolic, rumbling, low-pitched RATIONALES: Mitral stenosis causes a diastolic, rumbling, low-pitched murmur heard at the apex. A pansystolic, blowing, high-pitched murmur characterizes mitral insufficiency. A systolic, harsh, crescendo-decrescendo murmur occurs with aortic insufficiency. A diastolic, blowing, decrescendo murmur accompanies aortic insufficiency. NURSING PROCESS STEP: Assessment

A client receiving chemotherapy for metastatic colon cancer is admitted to the hospital because of prolonged vomiting. Assessment findings include irregular pulse of 120 bpm, blood pressure 88/48 mm Hg, respiratory rate of 14 breaths/min, serum potassium of 2.9 mEq/L (2.9 mmol/L), and arterial blood gas—pH 7.46, PCO2 45 mm Hg (6.0 kPA), PO2 95 mm Hg (12.6 kPa), bicarbonate level 29 mEq/L (29 mmol/L). The nurse should implement which prescription first?

5% Dextrose in 0.45% normal saline with KCl 40 mEq/L at 125 mL/h Explanation: The vital signs suggest that the client is dehydrated from the vomiting, and the nurse should first infuse the IV fluids with the addition of potassium. There is no indication that the client needs oxygen at this time since the PO2 is 95 (12.6 kPa). Although the client has a rapid and irregular pulse, the infusion of fluids may cause the heart rate to return to normal, and the 12-lead ECG can be prescribed after starting the intravenous fluids

The nurse is caring for a client with end-stage kidney disease. What arterial blood gas results are most closely associated with this disorder?

You selected: pH 7.20, PaCO2 36, HCO3 14- Explanation: Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3-) and to reabsorb sodium bicarbonate (HCO3-). There is also decreased excretion of phosphates and other organic acids.

thyroid storm

____is a rare form of thyrotoxicosis which occur with stressful illness, thyroid surgery or radioactive iodine. High mortality rate. Marked delirium, tachycardia, vomiting, diarrhea, dehydration, high fever, high T4, low TSH.

The physician has prescribed sodium chloride for a hospitalized 51-year-old client in metabolic alkalosis. Which nursing actions are required to manage this client? Select all that apply.

• Maintain intake and output records. • Document presenting signs and symptoms. • Compare ABG findings with previous results. Explanation: Metabolic alkalosis results in increased plasma pH because of accumulated base bicarbonate or decreased hydrogen ion concentrations. The result is retention of sodium bicarbonate and increased base bicarbonate. Nursing management includes documenting all presenting signs and symptoms to provide accurate baseline data, monitoring laboratory values, comparing ABG findings with previous results (if any), maintaining accurate intake and output records to monitor fluid status, and implementing prescribed medical therapy.

A client with acute renal failure is undergoing dialysis for the first time. The nurse monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: 1. confusion, headache, and seizures. 2. acute bone pain and confusion. 3. weakness, tingling, and cardiac arrhythmias. 4. hypotension, tachycardia, and tachypnea.

1. confusion, headache, and seizures. RATIONALES: Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiological functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication. NURSING PROCESS STEP: Assessment

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a client's uremia. Which finding signals a significant problem during this procedure? 1. Blood glucose level of 200 mg/dl 2. White blood cell (WBC) count of 20,000/mm3 3. Potassium level of 3.5 mEq/L 4. Hematocrit (HCT) of 35%

2. White blood cell (WBC) count of 20,000/mm3 RATIONALES: An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; it's readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isn't abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin. NURSING PROCESS STEP: Assessment

The nurse is interpreting a client's telemetry strip. If the QT interval is 0.52 second and the R-R interval is 1.72 seconds, how many seconds is the QTc interval (the QT interval corrected for the heart rate)?

Correct Answer: 0.39 RATIONALES: To correct the QT interval for variations in heart rate, divide the measured QT interval by the square root of the measured R-R interval. Square root of 1.72 = 1.31 0.52 ÷ 1.31 = 0.39 second The QTc should be less than 0.44 seconds in men, and less than 0.46 seconds in women. NURSING PROCESS STEP: Analysis